Small Vessel Disease and Dietary Salt Intake: Cross-Sectional Study and Systematic Review

Stephen D. J. Makin; Ghaida F. Mubki; Fergus N. Doubal; Kirsten Shuler; Julie Staals; Martin S. Dennis; Joanna M. Wardlaw

doi:10.1016/j.jstrokecerebrovasdis.2017.08.004

Small Vessel Disease and Dietary Salt Intake: Cross-Sectional Study and Systematic Review

Stephen D. J. Makin, Ghaida F. Mubki, Fergus N. Doubal, Kirsten Shuler, Julie Staals, Martin S. Dennis, Joanna M. Wardlaw^* (Corresponding Author)

^*Corresponding author for this work

Applied Health Sciences

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Abstract

BACKGROUND: Higher dietary salt intake increases the risk of stroke and may increase white matter hyperintensity (WMH) volume. We hypothesized that a long-term higher salt intake may be associated with other features of small vessel disease (SVD). METHODS: We recruited consecutive patients with mild stroke presenting to the Lothian regional stroke service. We performed brain magnetic resonance imaging, obtained a basic dietary salt history, and measured the urinary sodium/creatinine ratio. We also carried out a systematic review to put the study in the context of other studies in the field. RESULTS: We recruited 250 patients, 112 with lacunar stroke and 138 with cortical stroke, with a median age of 67.5 years. After adjustment for risk factors, including age and hypertension, patients who had not reduced their salt intake in the long term were more likely to have lacunar stroke (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.10-3.29), lacune(s) (OR, 2.06; 95% CI, 1.09-3.99), microbleed(s) (OR, 3.4; 95% CI, 1.54, 8.21), severe WMHs (OR, 2.45; 95% CI 1.34-4.57), and worse SVD scores (OR, 2.17; 95% CI, 1.22-3.9). There was limited association between SVD and current salt intake or urinary sodium/creatinine ratio. Our systematic review found no previously published studies of dietary salt and SVD. CONCLUSION: The association between dietary salt and background SVD is a promising indication of a potential neglected contributory factor for SVD. These results should be replicated in larger, long-term studies using the recognized gold-standard measures of dietary sodium.

Original language	English
Pages (from-to)	3020-3028
Number of pages	9
Journal	Journal of Stroke and Cerebrovascular Diseases
Volume	26
Issue number	12
Early online date	7 Sept 2017
DOIs	https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.08.004
Publication status	Published - 31 Dec 2017

Bibliographical note

Grant support: Wellcome Trust (grant 088134/Z/09/A); Scottish Funding Council and the Chief Scientist Office of Scotland for funding the
Scottish Imaging Network: A Platform for Scientific Excellence. F.D. holds an NHS Research Scotland and Stroke Association-Garfield Weston
Foundation Senior Lectureship (grant TSA Lect 2015/04). J.S. was supported by the MUMC Academic Fund. J.M.W. receives support from
the European Union Horizon 2020, PHC-03-15, project number 666881; “SVDs@Target,” the Fondation Leducq Network for the Study of Perivascular Spaces in Small Vessel Disease, reference number 16 CVD 05; and the Row Fogo Charitable Trust, reference number AD.ROW4.35.
BRO-D.FID3668413. The study was conducted independent of the funders.

Keywords

Dietary salt
urinary sodium/creatinine ratio
white matter lesions
acute stroke

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Cite this

@article{3c483074fb3840fea31f5970a4432a61,

title = "Small Vessel Disease and Dietary Salt Intake: Cross-Sectional Study and Systematic Review",

abstract = "BACKGROUND: Higher dietary salt intake increases the risk of stroke and may increase white matter hyperintensity (WMH) volume. We hypothesized that a long-term higher salt intake may be associated with other features of small vessel disease (SVD). METHODS: We recruited consecutive patients with mild stroke presenting to the Lothian regional stroke service. We performed brain magnetic resonance imaging, obtained a basic dietary salt history, and measured the urinary sodium/creatinine ratio. We also carried out a systematic review to put the study in the context of other studies in the field. RESULTS: We recruited 250 patients, 112 with lacunar stroke and 138 with cortical stroke, with a median age of 67.5 years. After adjustment for risk factors, including age and hypertension, patients who had not reduced their salt intake in the long term were more likely to have lacunar stroke (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.10-3.29), lacune(s) (OR, 2.06; 95% CI, 1.09-3.99), microbleed(s) (OR, 3.4; 95% CI, 1.54, 8.21), severe WMHs (OR, 2.45; 95% CI 1.34-4.57), and worse SVD scores (OR, 2.17; 95% CI, 1.22-3.9). There was limited association between SVD and current salt intake or urinary sodium/creatinine ratio. Our systematic review found no previously published studies of dietary salt and SVD. CONCLUSION: The association between dietary salt and background SVD is a promising indication of a potential neglected contributory factor for SVD. These results should be replicated in larger, long-term studies using the recognized gold-standard measures of dietary sodium.",

keywords = "Dietary salt, urinary sodium/creatinine ratio, white matter lesions, acute stroke",

author = "Makin, {Stephen D. J.} and Mubki, {Ghaida F.} and Doubal, {Fergus N.} and Kirsten Shuler and Julie Staals and Dennis, {Martin S.} and Wardlaw, {Joanna M.}",

note = "Grant support: Wellcome Trust (grant 088134/Z/09/A); Scottish Funding Council and the Chief Scientist Office of Scotland for funding the Scottish Imaging Network: A Platform for Scientific Excellence. F.D. holds an NHS Research Scotland and Stroke Association-Garfield Weston Foundation Senior Lectureship (grant TSA Lect 2015/04). J.S. was supported by the MUMC Academic Fund. J.M.W. receives support from the European Union Horizon 2020, PHC-03-15, project number 666881; “SVDs@Target,” the Fondation Leducq Network for the Study of Perivascular Spaces in Small Vessel Disease, reference number 16 CVD 05; and the Row Fogo Charitable Trust, reference number AD.ROW4.35. BRO-D.FID3668413. The study was conducted independent of the funders.",

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day = "31",

doi = "10.1016/j.jstrokecerebrovasdis.2017.08.004",

language = "English",

volume = "26",

pages = "3020--3028",

journal = "Journal of Stroke and Cerebrovascular Diseases",

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TY - JOUR

T1 - Small Vessel Disease and Dietary Salt Intake

T2 - Cross-Sectional Study and Systematic Review

AU - Makin, Stephen D. J.

AU - Mubki, Ghaida F.

AU - Doubal, Fergus N.

AU - Shuler, Kirsten

AU - Staals, Julie

AU - Dennis, Martin S.

AU - Wardlaw, Joanna M.

N1 - Grant support: Wellcome Trust (grant 088134/Z/09/A); Scottish Funding Council and the Chief Scientist Office of Scotland for funding the Scottish Imaging Network: A Platform for Scientific Excellence. F.D. holds an NHS Research Scotland and Stroke Association-Garfield Weston Foundation Senior Lectureship (grant TSA Lect 2015/04). J.S. was supported by the MUMC Academic Fund. J.M.W. receives support from the European Union Horizon 2020, PHC-03-15, project number 666881; “SVDs@Target,” the Fondation Leducq Network for the Study of Perivascular Spaces in Small Vessel Disease, reference number 16 CVD 05; and the Row Fogo Charitable Trust, reference number AD.ROW4.35. BRO-D.FID3668413. The study was conducted independent of the funders.

PY - 2017/12/31

Y1 - 2017/12/31

N2 - BACKGROUND: Higher dietary salt intake increases the risk of stroke and may increase white matter hyperintensity (WMH) volume. We hypothesized that a long-term higher salt intake may be associated with other features of small vessel disease (SVD). METHODS: We recruited consecutive patients with mild stroke presenting to the Lothian regional stroke service. We performed brain magnetic resonance imaging, obtained a basic dietary salt history, and measured the urinary sodium/creatinine ratio. We also carried out a systematic review to put the study in the context of other studies in the field. RESULTS: We recruited 250 patients, 112 with lacunar stroke and 138 with cortical stroke, with a median age of 67.5 years. After adjustment for risk factors, including age and hypertension, patients who had not reduced their salt intake in the long term were more likely to have lacunar stroke (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.10-3.29), lacune(s) (OR, 2.06; 95% CI, 1.09-3.99), microbleed(s) (OR, 3.4; 95% CI, 1.54, 8.21), severe WMHs (OR, 2.45; 95% CI 1.34-4.57), and worse SVD scores (OR, 2.17; 95% CI, 1.22-3.9). There was limited association between SVD and current salt intake or urinary sodium/creatinine ratio. Our systematic review found no previously published studies of dietary salt and SVD. CONCLUSION: The association between dietary salt and background SVD is a promising indication of a potential neglected contributory factor for SVD. These results should be replicated in larger, long-term studies using the recognized gold-standard measures of dietary sodium.

AB - BACKGROUND: Higher dietary salt intake increases the risk of stroke and may increase white matter hyperintensity (WMH) volume. We hypothesized that a long-term higher salt intake may be associated with other features of small vessel disease (SVD). METHODS: We recruited consecutive patients with mild stroke presenting to the Lothian regional stroke service. We performed brain magnetic resonance imaging, obtained a basic dietary salt history, and measured the urinary sodium/creatinine ratio. We also carried out a systematic review to put the study in the context of other studies in the field. RESULTS: We recruited 250 patients, 112 with lacunar stroke and 138 with cortical stroke, with a median age of 67.5 years. After adjustment for risk factors, including age and hypertension, patients who had not reduced their salt intake in the long term were more likely to have lacunar stroke (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.10-3.29), lacune(s) (OR, 2.06; 95% CI, 1.09-3.99), microbleed(s) (OR, 3.4; 95% CI, 1.54, 8.21), severe WMHs (OR, 2.45; 95% CI 1.34-4.57), and worse SVD scores (OR, 2.17; 95% CI, 1.22-3.9). There was limited association between SVD and current salt intake or urinary sodium/creatinine ratio. Our systematic review found no previously published studies of dietary salt and SVD. CONCLUSION: The association between dietary salt and background SVD is a promising indication of a potential neglected contributory factor for SVD. These results should be replicated in larger, long-term studies using the recognized gold-standard measures of dietary sodium.

KW - Dietary salt

KW - urinary sodium/creatinine ratio

KW - white matter lesions

KW - acute stroke

UR - https://www.ncbi.nlm.nih.gov/pubmed/28889932

U2 - 10.1016/j.jstrokecerebrovasdis.2017.08.004

DO - 10.1016/j.jstrokecerebrovasdis.2017.08.004

M3 - Article

SN - 1052-3057

VL - 26

SP - 3020

EP - 3028

JO - Journal of Stroke and Cerebrovascular Diseases

JF - Journal of Stroke and Cerebrovascular Diseases

IS - 12

ER -

Small Vessel Disease and Dietary Salt Intake: Cross-Sectional Study and Systematic Review

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Stephen Makin

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Small Vessel Disease and Dietary Salt Intake: Cross-Sectional Study and Systematic Review

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